Article

The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial.

School of Occupation and Leisure Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
Journal of the American Geriatrics Society (Impact Factor: 3.98). 10/2004; 52(9):1487-94. DOI:10.1111/j.1532-5415.2004.52411.x
Source: PubMed

ABSTRACT To test whether Stepping On, a multifaceted community-based program using a small-group learning environment, is effective in reducing falls in at-risk people living at home.
A randomized trial with subjects followed for 14 months.
The interventions were conducted in community venues, with a follow-up home visit.
Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.
The Stepping On program aims to improve fall self-efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower-limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two-hour sessions were conducted weekly for 7 weeks, with a follow-up occupational therapy home visit.
The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.
The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50-0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community-residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59).
The results of this study renew attention to the idea that cognitive-behavioral learning in a small-group environment can reduce falls. Stepping On offers a successful fall-prevention option.

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